Can someone with anorexia with diabetes be experiencing hypoglycemia?

[Guest878640]

If you had a patient who was 82 years old and recently had a loss of appetite, complains of being tired, and is unsteady on her feet and has had a fall, and her diagnosis is hypertension, coronary artery diseases and diabetes melltius type 2. (This is the current situation).

Her medications are glyburide, hydrochlorothiazide, lisinnopril, ASA.

Because she has a loss of appetite, she may be not drinking or eating very much, and this interacts with glyburide which is an antidiabetic drug and thus her condition may be hypoglycemia.

However one of the symptoms of hypoglycemia is hunger which she is not experiencing, so should I rule out hypoglycemia?

[akulahawkRN, ADN, RN, EMT-P]

Hunger isn't the only sign of hypoglycemia. People don't often experience all the symptoms of the diseases/conditions that they have... While it's possible to suspect hypoglycemia based on a constellation of symptoms, there's really only one way to definitively determine that.

How would you determine that?

By the way, I like the fact that you're thinking... but keep going.

[Guest878640]

"How would you determine that? "

By taking the blood glucose.

"Hunger isn't the only sign of hypoglycemia. People don't often experience all the symptoms of the diseases/conditions that they have... While it's possible to suspect hypoglycemia based on a constellation of symptoms, there's really only one way to definitively determine that."

Oh I see, but what if your patient is experiencing a symptom that is the opposite of the symptom listed? She does not have an appetite which is the opposite of hunger.

[Libby1987]

She's 82, do you think she would have the same hunger response of a younger adult?

Also, what measure do you take, or report to the dr for parameters, when a diabetic has a decreased food intake?

[ellieheart]

fingerstick 'em. If you can't do that on the spot, then give them something sweet to drink.

As far symptoms go, I'd be more concerned about things like diaphoresis, cool skin, and confusion. Hunger might be a very early symptom that disappears when confusion sets in.

[jadelpn, LPN, EMT-B]

Let's look at the whole patient approach. If this patient is all of sudden is refusing to eat (and dependent--did this patient have a good appetite to begin with?) there are many reasons that could explain why. Perhaps she doesn't like "diabetic" food. She could have gastric distress. She could be generally feeling unwell. Or she could be nearing the end of her life, where hunger is something that is not present.

Because she is not eating (and by not eating--does this mean not drinking as well?) then a change in the plan of care needs to be discussed with the MD. FBS and a sliding scale for insulin may be what is warranted at present. Watch her B/P as sometimes the need for a dose change could get rid of the unsteadiness.

And ask the MD to have discussion with patient and family on what the goal is. Do they want labs to see what's going on? Is there a UTI that needs treatment? Do you need to think about tracking both B/P and FBS for adjustments in medications? Do they want to start some IV fluid?

I wouldn't rule anything out without a full picture. I would not get aggressive unless that is what the patient and/or family want. The goal should it not be is comfort, peaceful, pain free and safe.

One of the most difficult things to imagine/realize is that yesterday this patient could have been spry, with-it, functional. And today, not so much, and the next day REALLY not at all. Be clear on the goal for the plan of care. Keep her safe. And make sure that you advocate for if said patient wants a milkshake, a piece of chocolate, or fried chicken with chocolate cake, that you may be able to provide that as a regular diet if clearly this patient is in the end stage of her life. (and NOOOO I do not advocate this for one's typical middle aged diabetic, however, this may be very near the end for this patient, and she may or may not want to eat something she loves).

Best wishes

[PsychNurseWannaBe, BSN, RN]

As a diabetic, I have learned that diabetics experience the disease differently (I'm generalizing) But for me, I don't get the typical S/S of hypo or hyperglycemia at times. The only way to know is for me to check my blood sugar. I could feel completely fine and be well over 200 and there are times I feel sick and I'm within parameters. The person could be having a hypoglycemic reaction. For example, if I give myself insulin and drop quite a bit of points rapidly but now I am "normal", I sometimes will get sick because I dropped too fast. A hypoglycemic reaction is not simply that a person is actually hypoglycemic.... if that makes sense. Short story long. LOL... alert the MD and see about getting some blood sugar readings.

[PsychNurseWannaBe, BSN, RN]

One last thing and I swear I am off to bed. If the person isn't drinking as well either, she is taking a diuretic and could be dehydrated. Her fluid and electrolytes could be off which could contribute to a fall, confusion, decreased appetite.